Provider Demographics
NPI:1023076866
Name:TSENG, PETER Y (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:Y
Last Name:TSENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4086
Mailing Address - Country:US
Mailing Address - Phone:810-985-3712
Mailing Address - Fax:
Practice Address - Street 1:1221 PINE GROVE AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3511
Practice Address - Country:US
Practice Address - Phone:810-985-2663
Practice Address - Fax:810-989-3174
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052718207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102866032Medicaid
MIF34908Medicare UPIN
MI102866032Medicaid